Successful first-line treatment of simultaneous multiple primary malignancies of lung adenocarcinoma and renal clear cell carcinoma: A case report

Abstract

Background: Multiple Primary Malignancies (MPMs) refer to the occurrence of two or more primary malignancies in the same organ or multiple organs and tissues of the same patient simultaneously or sequentially, with an incidence rate ranging from 2-17%. According to the difference in the time of occurrence of each primary tumor, MPMs can be classified as simultaneous malignancies and heterochronic malignancies. The former refers to the occurrence of two or more malignancies one after another within 6 months, while the latter refers to the occurrence of two malignancies at an interval of more than 6 months. Currently, there is a lack of effective treatment options for MPMs both nationally and internationally.

Case presentation: The patient was a 65-year-old male smoker with a definite diagnosis of advanced lung adenocarcinoma with kirsten rat sarcoma viral oncogene (KRAS) mutation, concomitant with primary renal clear cell carcinoma (RCCC), who had a progression-free survival (PFS) for 7 months after first-line treatment with albumin-bound paclitaxel and cisplatin in combination with sintilimab.

Conclusion: In this paper, we report a case of advanced lung adenocarcinoma combined with RCCC as a concurrent double primary malignancy, which achieved a satisfactory outcome after first-line chemotherapy combined with immunotherapy, with the aim of exploring effective treatment modalities for this type of MPMs, in order to improve the survival and prognosis of the patient.

Keywords: chemotherapy; immunotherapy; lung adenocarcinoma; multiple primary malignancies; renal clear cell carcinoma.

Figure 1

CT of the lungs at different times. (A–D) Mediastinal Window; (E–F) window of lung fields. (A) Pulmonary lesion before treatment. (B) CT revealed a stable disease after 2 cycles of albumin-bound paclitaxel and cisplatin in combination with sintilimab. (C) CT revealed a stable disease after 6 cycles of albumin-bound paclitaxel and cisplatin in combination with sintilimab. (D) CT showed no significant changes in the primary lesion of the left lung after sequential 2 cycles of sintilimab immune monotherapy maintenance treatment. (E)The window of lung fields after 6 cycles of albumin-bound paclitaxel and cisplatin in combination with sintilimab. (F) CT revealed pulmonary metastases increased after sequential 2 cycles of sintilimab immune monotherapy maintenance treatment (as the red arrow).

Figure 2

Abdominal CT at different times. (A) The left kidney lesion before treatment. (B) CT revealed a stable disease after 2 cycles of albumin-bound paclitaxel and cisplatin in combination with sintilimab. (C) CT revealed a stable disease after 6 cycles of albumin-bound paclitaxel and cisplatin in combination with sintilimab. (D) No significant change in left kidney lesion after sequential 2 cycles of sintilimab immune monotherapy maintenance treatment.

Figure 3

Whole body bone imaging showed increased radioactivity in the third thoracic vertebra with bone destruction.

Figure 4

Tissue sections stained with hematoxylin-eosin. (A) Adenocarcinoma of the left lung. (B) Left renal clear cell carcinoma.

Figure 5

PD-L1 protein expression on tumor cells was detected by VENTATA PD-L1(SP263). (A) The results was negative. (B) The results was negative.

Figure 6

Time flow chart of the diagnosis and treatment process of this patient. (C2 represents 2 courses of treatment, C4 represents 4 courses of treatment, C6 represents 6 courses of treatment, C2 maintenance therapy represents 2 courses of maintenance therapy).

Figure 7

Changes in tumor marker content. Cytokeratin 19 fragment, CEA, CA125 and NSE were abnormally increased before treatment, after 2 courses of treatment, cytokeratin 19 fragment and NSE decreased significantly. After 6 courses of treatment, CEA and CA125 also decreased significantly.

Figure 8

Changes of peripheral blood inflammatory indexes. The content of ANC, CRP and the ratio of NRL gradually decreased after treatment.

Figure 9

Changes in the proportion of T cells in peripheral blood. With the treatment progressed, the content of CD3⁺ and CD3⁺CD4⁺ increased until the end of 6 courses of treatment.